Dental care is among the areas of highest unmet need for lower-income children. Dental insurance is an important factor related to the use of dental services by children. High unmet need has encouraged most state SCHIP programs to include dental benefits, however, little is known about program effects on access to care and costs. Iowa's combination SCHIP and Medicaid programs provide a natural experiment for evaluating the effect of different types of dental insurance models on the use and costs of services for children in these programs. Three different types of dental insurance plans operate in the S-SCHIP program (indemnity, open access panel and closed panel HMO) and one in the M-SCHIP and Medicaid programs (Medicaid fee-for-service). The specific aims of this study include: (1) determine dental services utilization for children in the Iowa SHIP and Medicaid programs, (2) determine the factors related to unmet dental need (i.e., not meeting professional guidelines for an annual dental check-up) for children, (3) determine the factors related to 'self-reported' unmet dental need for children, and (4) determine the costs associated with providing dental care for children in Iowa's SHIP and Medicaid programs and whether there is pent-up demand for dental care. These aims will be evaluated using administrative data from the SHIP and Medicaid programs and survey data from program enrollees. The central hypothesis is that the type of dental insurance plan will be significantly related to access to dental care and that the traditional fee-for-service Medicaid and closed panel HMO model programs will have lower access to care due to more limited provider panels. Other predisposing factors (e.g., age, child's reported health status, time without dental insurance) will also be evaluated following the Health Behavior Model as the conceptual basis for the analyses. Programmatic costs will be evaluated by applying plan reimbursement rates to utilization of services. Pent-up demand will be evaluated by determining (1) if dental care costs were higher when the SHIP program first began, and (2) if individual costs were higher when children first joined SHIP or Medicaid. The long-range goal is to improve policymakers' understanding of dental care costs and to provide them with information that can increase access to dental care. The results should help to realize the Healthy People 2010 goal of improving dental access to low-income children and adolescents.